Abstract 16802: Disparities in the Prevalence of Atrial Fibrillation and Associated Risk Characteristics Among Black and White Acute Ischemic Stroke Patients Treated With Alteplase

Introduction: Earlier studies addressing racial disparity in patients with acute ischemic stroke (AIS) and atrial fibrillation included significantly lower percentage of blacks. Demographics and post-intervention risk among white vs. black patients with AIS and AF have not been reported in a community hospital setup.

Methods: In this retrospective analysis, baseline demographics, procedural characteristics and one-year clinical outcomes were collected from hospital database and compared between blacks and whites who are admitted with AIS and treated with alteplase.

Results: 228 and 274 black patients with AIS admitted to our hospital during 2016 to 2021 were included in the analysis. Blacks compared to whites were younger (67 ±13 vs. 74 ± 14 years) and had lower prevalence of cardioembolism (49% vs. 61%), atrial fibrillation (10% vs. 34%), coronary artery disease (17% vs. 26%), prior coronary artery disease or myocardial infarction (17% vs. 26%), depression (16% vs. 25%), dyslipidemia (53% vs. 65%), ischemic risk at admission (6.1 ± 3.6 vs. 8.2 ± 3.8), and NIHSS-obtained (11±11 vs. 14±13), but higher prevalence of small vessel disease (15% vs. 7.9%), cryptogenic stroke (20% vs. 13%), diabetes (39% vs. 25%), smokers (26% vs. 14%), drug/alcohol abuse (21% vs. 9%), prior stroke (24% vs.15%) and one year recurrent ischemic stroke (4.7 % vs. 1.3%) (p<0.05 for all comparisons). Among patients with AF, blacks were of similar age compared to whites (75±13 vs. 79±14 years) and similar prevalence of cardioembolism (99% and 96%), prior myocardial infarction/coronary artery disease (26% vs. 30%) and obesity (59% vs. 48%, p=ns for all), but higher prevalence of prior stroke (48% vs. 20%), diabetes (41% vs. 22%), renal insufficiency 30% vs. 18%) and recurrent ischemic stroke (7.4% vs. 1.3%, p<0.05 for all).

Conclusions: Blacks patients with AIS exhibit distinct demographics and higher prevalence of recurrent ischemic events compared to whites. Despite lower prevalence, blacks with AIS have higher prevalence of comorbidities and recurrent stroke events in the presence of AF. These data provide springboard for ongoing biomarker studies at our hospital to understand the racial disparity in the underlying pathophysiology of stroke and associated outcomes in blacks.